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Travel Medicine Updates

Travel Medicine Updates. Rushabh Shah Regis University PharmD Candidate Class of 2014 7/18/13. Outline. Travelers’ Health Epidemiology Traveler Assessment Risk to the traveler Travel Disease Updates Malaria Japanese Encephalitis Typhoid Rabies Future Research Hepatitis C.

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Travel Medicine Updates

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  1. Travel Medicine Updates Rushabh Shah Regis University PharmD Candidate Class of 2014 7/18/13

  2. Outline • Travelers’ Health Epidemiology • Traveler Assessment • Risk to the traveler • Travel Disease Updates • Malaria • Japanese Encephalitis • Typhoid • Rabies • Future Research • Hepatitis C

  3. US Residents Traveling Abroad US Department of Commerce: Office of Travel and Tourism Industries tinet.ita.doc.gov/outreachpages/download_data_table/2011_US_travel_Abroad.pdf

  4. Where do US Residents Travel? US Department of Commerce: Office of Travel and Tourism Industries tinet.ita.doc.gov/outreachpages/download_data_table/2011_US_travel_Abroad.pdf

  5. Travelers Assessment • Age Specific Issues • Underlying Illness, immunosuppression • Systems Review • Medical History • Medication Use • Vaccination History • Allergies • Contraindication to vaccines and medications • Reproductive • Pregnant • Breast-feeding • Preconception

  6. Infectious Disease Risks to the Traveler • Malaria • Diarrhea • Rabies • Meningococcal Meningitis • Measles • Tuberculosis • Typhoid Fever • Polio • Yellow Fever • Japanese Encephalitis

  7. Malaria • Disease spread through Mosquito bites • Most common P. falciparum and P. vivax • Symptoms • High Fever • Shaking Chills • Flu- like illness • Prevention • Prevent Mosquito bites • Medications • Malarone • Chloroquine • Mefloquine • Primaquine • Doxycycline • Hydroxychloroquine (Second Line) 1. Malaria. CDC resources page Center for disease Control. http://wwwnc.cdc.gov/travel/diseases/malaria

  8. 1. Malaria. CDC resources page Center for disease Control. http://wwwnc.cdc.gov/travel/diseases/malaria

  9. 1. Malaria. CDC resources page Center for disease Control. http://wwwnc.cdc.gov/travel/diseases/malaria

  10. Malaria Future Research • Malaria • RTS,S (Mosquirix) • Phase III Trial • Infants 6-12 weeks, protects against P.falciparun • 33% fewer episodes of clinical and severe malaria over 12 months of follow up • No increase in Serious Adverse Events • Long term efficacy 1. Malaria Vaccine. http://www.malariavaccine.org/about-overview.php

  11. Typhoid Fever • Spread through contaminated food and water • Symptoms • High fever • Weakness • Stomach Pain • Headache • Loss of Appetite • Vaccines • Inactivated IM Injection (Typhim Vi) • 1 Dose, 2 weeks prior to travel • Booster dose needed every 2 years • Live, Weakened, Oral Vaccine (Vivotif) • 4 doses, 1 week prior to travel • Booster dose needed every 5 years 1. Typhoid Fever. CDC resources page Center for disease Control. http://wwwnc.cdc.gov/travel/diseases/typhoid

  12. Japanese Encephalitis • Disease spread through mosquito bites • Symptoms • Fever • Headache • Vomiting • Difficulty moving • Prevent mosquito bites • Vaccine • IXIARO® *Change in Recommendation* • ≥2 months to <3 years old- 0.25mL IM • ≥3 Years old- 0.5mL IM • 2 doses (Day 1; 28 Days after dose 1), 7 days prior to travel 1. Japanese Encephalitis. CDC resources page Center for disease Control. http://wwwnc.cdc.gov/travel/diseases/japanese-encephalitis

  13. Rabies • Viral disease that causes acute encephalitis in warm- blooded animals • Symptoms • Malaise • Headache • Fever • Violent Movement • Uncontrolled excitement • Depression • Vaccine • Preventive Exposure 3 doses (0,7, 21 or 28) • Post-Exposure, Not Vaccinated 4 doses (0,3,7,14) • Post Exposure, Vaccinated 2 doses (0,3) 1. Rabies. CDC resources page Center for disease Control http://wwwnc.cdc.gov/travel/diseases/rabies

  14. Future Research • Hepatitis C • Multi- antigen DNA vaccine covering Hepatitis C virus genotypes 1a and 1b and antigen NS3/4A as well as NS4B/5A • Phase I/IIA clinical study • Strong NS3- specific interferon-Γ (IFN-Γ) • Robust CD4 and CD8 T cell proliferation • Induction of polyfunctional T cells • HIV • AIDSVAX/RV144 • Targeted GP120 Hepatitis C Vaccine. http://ir.inovio.com/2013-01-09-Inovio-Pharmaceuticals-to-Initiate-Clinical-Trial-for-its-Hepatitis-C-Therapeutic-Vaccine-INO-8000-Later-this-Year Thai Phase III HIV Vaccine Clinical Trial. www.hivresearch.org/research.php?ServiceID=13 N Engl J Med (366) 1275-1286. April 5, 2012

  15. Travel Medicine Rushabh Shah Regis University PharmD Candidate Class of 2014 Acknowledgment to Dr. Christy Harmon

  16. Questions?

  17. Citations • US Department of Commerce: Office of Travel and Tourism Industries tinet.ita.doc.gov/outreachpages/download_data_table/2011_US_travel_Abroad.pdf Accessed July 16, 2013 • Malaria. CDC resources page Center for disease Control. http://wwwnc.cdc.gov/travel/diseases/malaria Accessed July 16,2013. • Japanese Encephalitis. CDC resources page Center for disease Control. http://wwwnc.cdc.gov/travel/diseases/japanese-encephalitis Accessed July 16,2013. • Typhoid Fever. CDC resources page Center for disease Control. http://wwwnc.cdc.gov/travel/diseases/typhoid Accessed July 16,2013. • Rabies. CDC resources page Center for disease Control. http://wwwnc.cdc.gov/travel/diseases/rabies Accessed July 16,2013. • Malaria Vaccine. http://www.malariavaccine.org/about-overview.php Accessed July 16, 2013 • Hepatitis C Vaccine. http://ir.inovio.com/2013-01-09-Inovio-Pharmaceuticals-to-Initiate-Clinical-Trial-for-its-Hepatitis-C-Therapeutic-Vaccine-INO-8000-Later-this-Year. Accessed July 16, 2013 • Thai Phase III HIV Vaccine Clinical Trial. www.hivresearch.org/research.php?ServiceID=13 • Haynes B.F., Gilbert P.B., McElrath M.J., et. al. Immune- Corraletes Analyses of an HIV-1 Vaccine Efficacy Trial. N Engl J Med (366) 1275-1286. April 5, 2012

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